This is a case of a 28-year-old-woman, G2P1, with no known obstetrics risk factors and no relevant medical history. The first ultrasound showed diamniotic dichorionic twin pregnancy. The pregnancy was uncomplicated, patient was not aware of fever or any signs of infection, shortly before conception and in the first and second trimester of the pregnancy. The first trimester scan was normal, with NT=1 mm for both fetuses. Triple test was negative.

The second trimester scan performed at 22 weeks of gestation showed two female fetuses with normal growth. There were no abnormalities seen during the ultrasound examination.

The following ultrasound examination was done at 24 weeks of gestation with the following findings:

Twin A

Ultrasound scan revealed cerebral anomalies and these findings were confirmed by the follow-up ultrasound at 27 weeks:

We performed an amniocentesis at 31 weeks. The fetal karyotype was normal 46 XX for both fetuses. We also tested the amniotic fluid for Herpes simplex virus, Cytomegalovirus and Parvovirus B19. MRI images confirmed the ultrasound findings in both fetuses, lissencepahly, bilateral ventriculomegaly and agenesis of the corpus callosum at twin A. Twin B showed lissencephaly with enlarged cisterna magna.

Patient decided for the pregnancy termination at 33 weeks based on the counseling with neonatologist, neurologist and psychiatrist. They explained the adverse prognosis for both twins, spasm, seizures, failure to thrive, deafness.

The final results showed a presence of cytolomegalovirus in the amniotic fluid.